Organ Transplantation

The only gift is a portion of thyself - Ralph Waldo Emerson

Organ Transplantation

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A quiet revolution is underway in human transplantation. Four children have been born to women in Sweden who were given a uterus by their mother or sister. Face and hand transplants have been performed in France, Turkey, China, Spain and the United States with the latest face transplant being announced yesterday at my institution, NYU Langone. Plans are in the works to use cadaver sources for uteri. Voiceboxes have also been done and teams are gearing up to transplant the penis, ovary and fallopian tube. Some of these parts can come from the living but all of them will primarily come from the newly dead.

One key reason all these new forms of transplantation are revolutionary is that they involve non-life-saving organs. Unlike heart, liver, kidney and lung transplants, they are being done to enhance the quality of life or to palliate suffering. Some are being done not to save lives but to allow individuals to create new ones.

These are manifestly ethical goals. But the shift away from saving lives to making them better involves a shift in the ethical thinking that has long formed the foundation of organ transplantation. They require doctors, patients, regulators and the rest of us to rethink the risk and benefit ratio represented by these new forms of transplant.

Powerful and noxious agents, immunosuppression, must be used to keep transplanted organs from rejecting. These drugs cause all manner of nasty side-effects over time including, ironically, fatal organ failure. When facing certain death due to heart or liver failure, the long-term risk of immunosuppression does not loom large. But giving immunosuppression that can shorten a life and cause other impairments to permit a face, hand, uterus or penis to be transplanted creates a different risk-benefit ratio—quality of life and risk versus quantity of life and risk.

Organ donation may be impacted by these new forms of transplant as well. It is one thing, emotionally, to donate a relative’s or partner’s liver or a kidney, quite another to give their face, hand or uterus. Current law and regulation treats all the same in terms of donation. But it remains to be seen how the public will accept the newer forms of transplant in responding to requests for donation.

The notion of the extent to which families and friends of deceased donors can be involved with recipients is shifting as well. Seeing a loved one’s hand or face on another person or knowing that your deceased daughter’s uterus helped bring a new baby into the world is likely to stress the traditional drive to insure the privacy of recipients.

Transplanting a face to allow a person to reenter society without stigma or scorn is a wondrous thing. Allowing a woman to bear a child in a society or state where gestational surrogacy is not even an option will find some eager to try. But the new world of transplant requires revisiting some old ways of ethical thinking to help grapple with an entirely new set of opportunities and challenges.

Source: Arthur Captan, A Quiet Revolution In Organ Transplants, Forbes, November 17, 2015.

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Last Updated : Tuesday, July 7, 2020